Critter SittersDoggie Daycare & Boarding Enrollment Form

FOR OFFICE USE ONLYEnrollment Form Shots Staff ScreenedComputer Entry Folder First Day

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EMERGENCY CONTACT INFORMATION

Owner Information

Name: _________________________________________________________________________________

Address:_______________________________________________________________________________

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E-Mail: _______________________________________________________________________________

Home Phone: ______________________________ Work Phone: ________________________

Cell Phone: _______________________________

Emergency Contact

Name: ________________________________________________________________________________

Home Phone: ______________________________ Work Phone: ________________________

Cell Phone: ________________________________

Pet Information

Name: ___________________________ Breed: _________________________ Sex: __________

Age: ________________________ Weight: ________________________

Veterinarian

Name: ________________________________________________________________________________

Address: ______________________________________________________________________________

Phone: ________________________________________________________________________________Pet Personality Profile

General InformationHow did you hear about Critter Sitters? _________________________________________________________

Dog’s Name: ________________________________ Date you acquired dog: ____________________

Dog’s Breed, Sex, and Age: __________________________________________________________________

Is dog spayed/neutered? _______________________ If yes, at what age? _______________________

Where did you get your dog? __________________________________________________________________

If adopted, what knowledge do you have of your dogs past history? ___________________________________

Is your dog good with children, cats or other dogs? _________________________________________________

Are there other animals in your household? If yes, please list type, sex and age of each:

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Health/Grooming

Is your dog treated for fleas/ticks? ____________ Allergies or dietary restrictions? ________________

Is your dog treated with a heartworm preventative? ____________

Is your dog up to date on all shots/immunizations including Bortadella (kennel cough)? _____________________

Is your dog currently taking any medications or supplements? _____________ If yes, please list what for and the

dosing instructions: ___________________________________________________________________________

Does your dog have hip dysplasia? ____________ If yes, what restrictions need to be placed on your dog’s

Activities or movements? _______________________________________________________________________

Does your dog allow brushing? _______________________ Nail clipping? ______________________

BehaviorDoes your dog appear afraid of any specific items or noises? If yes, please explain:_______________________

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How does your dog react to strangers coming into your home or yard? _________________________________

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Does your dog ever bark or growl at anyone passing outside of your home or yard? ________________________

Are there any people your dog automatically fears or dislikes? If yes, please explain: ______________________

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Are there any dogs your dog automatically fears or dislikes? If yes, please explain.________________________

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How does your dog react to puppies? ____________________________________________________________

Has your dog ever:

Growled at someone? ________________ If yes, what were the circumstances? ________________

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Bitten someone? ____________________ If yes, what were the circumstances? ________________

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Does your dog have problems in any of the following areas? If yes, please explain:

Nipping/Mouthing: ___________________ Housetraining: ______________________________

Barking: ___________________________ Digging: ___________________________________

Jumping: __________________________ Other: _____________________________________

Has your dog ever growled or snapped at someone who has taken his/her food or toys away? If yes, what were the

Circumstances? ________________________________________________________________________________

Has your dog ever shared his/her food or toys with other animals? ______________________________________

Does your dog play with other dogs? ______________________________________________________________

Has your dog ever had formal obedience training? __________ If yes, when and where? _____________________

What commands does your dog know? ____________________________________________________________

Other comments about your dog you feel may be helpful: __________________________________________

Critter SittersOWNER AGREEMENT

I, _____________________________, hereby certify that my dog(s) ______________________________Is (are) in good health and has not been ill with any communicable condition in the last 30 days. I further certify that my dog(s) has not harmed or shown aggressive or threatening behavior toward any person or any other dog. I have read and understand the following:

1. I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is attending Critter Sitters Dog Daycare Center (“Center”).

2. I further understand and agree that in admitting my dog(s) to the Center, Critter Sitters staff have relied on my representation that my dog(s) is in good health and have not harmed or shown aggressive or threatening behavior towards any person or other dog.

3. I further understand and agree that Critter Sitters and their staff, will not be liable for any problems which develop, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog(s) attendance and participation at the Center.

4. I further understand and agree that any problems which develop with my dog(s) will be treated as deemed best by the staff of Critter Sitters at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.

I certify that I have read and understand the policies of the Center as set forth on the preceding pages and that I have read and understand the conditions, and statements of this agreements, including the following:

FEES: $30 per day, per dog for Doggie Daycare. $35 per day, per dog for boarding.

RESERVATIONS: Reservations and Appointments Required. Cancellations with less than 24 hours notice will be charged full fees.

Signature of Owner: ___________________________________

Date: _______________________________________________